infants apical pulse

i am having a hard time taking newborns apical pulses. i start ok but then i get fuster around 15 secs in and lose my count because there heart rate is so fast. i am asking for help from experience ob nurses on trick of the trade. this is my only vital sign i struggle with.

I had this problem last semester when in my OB/pedi rotation. Newborn nursery was my first rotation. I didn't realize that it would be so hard to take VS on a healthy patient!

It wasn't until my pedi rotation that I learned The Trick. My pedi instructor said to count it in 15 sec intervals and then add up the 4 counts - much easier than 1,2,3,...77, 78....87,78..no wait, was I on 80 or 70?...crap, gotta start all over! She said it didn't have to be one single entire minute - that's practically impossible, just take 15 sec counts over a couple of minutes. Turns out that a LOT easier and FASTER than starting all over again. Would have saved me a lot of grief in my nursery rotation had I known then.

Feb 23, '06

Quote from maolin

It wasn't until my pedi rotation that I learned The Trick. My pedi instructor said to count it in 15 sec intervals and then add up the 4 counts - much easier than 1,2,3,...77, 78....87,78..no wait, was I on 80 or 70?...crap, gotta start all over! She said it didn't have to be one single entire minute - that's practically impossible, just take 15 sec counts over a couple of minutes. Turns out that a LOT easier and FASTER than starting all over again. Would have saved me a lot of grief in my nursery rotation had I known then.

Yep, that's what we do in the NICU as well. Same for respirations - easier to count over 15 seconds and multiply by 4.

Feb 23, '06

thanks good advice

Feb 23, '06

I know it's silly, but I tap my toe- I don't think I do it on purpose, it's just what I do- somehow it keeps me on target.

Feb 23, '06

Another silly hint that helps me, close your eyes, I dont know why but I can only listen if I cant see.

Feb 23, '06

Quote from MissJoRN

I know it's silly, but I tap my toe- I don't think I do it on purpose, it's just what I do- somehow it keeps me on target.

Actually, that's on the right track. Another good method is to tap your finger as you count. In the Neonatal Resuscitation Program (NRP), we are taught to do this so that everyone involved in the resuscitation can actually see how fast the heart is beating while they are working on the baby.

Feb 23, '06

You might also try counting every other beat, realizing that you'll have to multiply by two.

Feb 23, '06

Quote from BRANDY LPN

Another silly hint that helps me, close your eyes, I dont know why but I can only listen if I cant see.

Not silly at all! I close my eyes to listen for murmurs, especially if I think there is a soft murmur.

Feb 23, '06

Quote from BRANDY LPN

Another silly hint that helps me, close your eyes, I dont know why but I can only listen if I cant see.

That's what I do! That and tap my finger...
It was highly *recommended* by our Clinical Practice Managers that on babies less than 24 hours we listen for a full minute to assess for any abnormal heart sounds (irregular, regular, murmur, etc). I don't know why they limit it to 24 hours because I had a baby at 36 hours of age that would occasionally look what appeared to be facial congestion and it was a cyanotic heart defect-upon full assessment of the cardiac rate, the baby started out *normal* than abruptly be very bradycardic.
Our NICU does a full 1 minute cardiac rate on all babies except strict feeders.

Feb 23, '06

Quote from SuperFlyRN

Our NICU does a full 1 minute cardiac rate on all babies except strict feeders.

We do a full minute upon admission, but many of our babies can't tolerate it so we don't do it with every set of vitals. Many of the sick ones desaturate just from having the stethescope on their chests so we do a 15 second count, then listen to lung fields, then abdomen. If a baby has a murmur, and you can recognize it, you'll hear it in those 15 seconds.

Feb 24, '06

We are asked by our peds and NNP to do 1 minute apical pulses on all newborns, particularly on the initial shift assessment, on newborns with known murmurs or irregular rhythms, and other problems, and initially at birth. What helps me is:

Having a good quality pedi stethoscope; this is so important esp if you are inexperienced at auscultating newborn heart beats.

As quiet an environment as possible---dont' be afraid to let visitors/others know you need a minute to listen to the baby; it's that important.

I have sometimes tapped my finger on the crib or another surface, to the beat of the heart, if its very fast---this somehow helps me stay on track well. It's really important you know the rate, rhythm and sounds of the baby's heart-----tapping helps you see how regular that really is.

I am sorry, but you really cannot often pick up murmurs and other abnormal sounds/rhythms with just 15 seconds oftentimes; try to do apical pulse auscultation for at least one minute on all babies every shift, and every time for kids who have audible murmurs or irregular rhythms.

With practice, it does get MUCH easier; you will be a pro soon.

Last edit by SmilingBluEyes on Feb 24, '06

Feb 24, '06

Quote from SmilingBluEyes

I am sorry, but you really cannot often pick up murmurs and other abnormal sounds/rhythms with just 15 seconds oftentimes; try to do apical pulse auscultation for at least one minute on all babies every shift, and every time for kids who have audible murmurs or irregular rhythms.

With healthy kids in the normal newborn nursery, maybe it is easy to get a full minute. I'm just saying that when you're trying to get an apical pulse on a 400 gram baby that desaturates the second you touch it, you don't really have that option.

But these are students with normal newborns that we're talking about - so yeah, a full minute is a better idea. Closing your eyes and tapping your finger or toes, and asking for the family to be quiet for a minute - those are all really good tips to try and get a full minute. Maybe try putting a pacifier in the baby's mouth, if it's allowed by the parents - the baby will probably be less squirmy then and you will be able to concentrate on listening and counting rather than keeping the baby calm.

Also ask the nurses in the nursery if any of the babies has a murmur and see if you can listen to it. The more abnormalities you hear, the easier it gets to pick up problems.